Medical Oncology: Melanomas

It provides assessment, consultation, support, follow-up and treatment (adjuvant and therapeutic) for patients with cutaneous, mucosal and ocular melanoma.
Its mission is to participate in international and national multicentre clinical trials aimed at improving the standard of care (molecularly targeted therapy and immunotherapy) for the condition, in both adjuvant and metastatic settings. The study of these therapies is conducted in close collaboration with the preclinical sector, with a view to identifying prognostic and response-predictive biomarkers. Furthermore, particular focus is placed on the mechanisms of anti-tumour immune response and the associated mechanisms of resistance, as well as the genetic characterisation of tumour cells and the tumour microenvironment.
Multidisciplinary assessments and treatments are provided to all patients who require them.
It is a unit affiliated with the Medical Oncology 1 Department.
Outpatient services are provided within the Melanoma Group, involving the assessment and recruitment (initial consultations) of patients who may be eligible for clinical trials based on targeted therapy and immunotherapy using immune checkpoint inhibitors, as well as experimental drugs.
A multidisciplinary meeting is held every week to manage clinical cases relating to cutaneous and mucosal melanomas, attended by surgeons, medical oncologists, radiologists, nuclear medicine specialists, pathologists and molecular biologists.
A weekly multidisciplinary meeting is also held for ocular melanoma, attended by an ophthalmic oncologist, medical oncologist, surgeons and psychologists.
This, in conjunction with the unit’s research activities, makes the Institute a national centre of excellence for the condition.
The Clinical Unit carries out its specific activities in accordance with internal quality protocols, which are reviewed and updated periodically.

CLINICAL ACTIVITIES
Outpatient services are provided as part of the melanoma treatment programme, which includes treatment appointments and follow-up consultations on Mondays (mornings and afternoons), Tuesdays (mornings), Wednesdays (mornings), Thursdays (mornings) and Fridays (mornings and afternoons). Initial consultations are held in the afternoon (2.00–5.00 pm) on Tuesdays and Wednesdays each week, with the primary aim of identifying patients who may be suitable candidates for clinical trials.
Normally, 10–12 initial consultations are carried out per week (approximately 40–48 consultations per month) and an average of 18 consultations per day spread throughout the week, including infusion therapies (immunotherapies) and oral therapies (targeted therapies).

RESEARCH ACTIVITIES
The research activities of the SS are aimed at optimising innovative therapeutic strategies in the field of molecularly targeted therapies and immunotherapies for melanoma, both in adjuvant/neoadjuvant settings and in metastatic settings. Main lines of research: 1. Modelling/remodelling of metastases and the tumour immune microenvironment to improve the efficacy of immunotherapy (AIRC 5x1000 2018): the project aims to characterise in depth the epigenetic mechanisms that regulate the functional immune relationships between the tumour cell compartment, the tumour microenvironment, and immune cells, which contribute to metastasis, tumour progression, and resistance to immune checkpoint inhibitors. 2. Precision immunotherapy for cancer treatment: understanding resistance mechanisms, improving patient selection, and designing new therapeutic strategies (RF 2016): The hypothesis to be tested involves the identification of biomarkers, baseline and/or during therapy, shared in peripheral blood that correlate with specific clinical outcomes in patients with solid tumours of different histological types undergoing treatment with various ‘immune checkpoint inhibitors’ 3. T-WIN translational clinical trial in collaboration with the Institute for Genetic and Biomedical Research, CNR, Sassari: Patterns of response/progression to first-line treatment with Dabrafenib and Trametinib in patients with metastatic/unresectable BRAF-mutated melanoma (Supported by Novartis).